Zero-Profile Interbody Spacer and Coupled Plate Assembly

ABSTRACT

An implant for insertion into the disc space between vertebrae. The implant including a spacer portion, a plate portion coupled to the spacer portion, a plurality of bone fixation elements for engaging the vertebrae and a retention mechanism for preventing the bone fixation elements from postoperatively uncoupling from the implant.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/614,082, filed Nov. 6, 2009, entitled Zero-Profile Interbody Spacerand Coupled Plate Assembly, which claims priority to U.S. ProvisionalPatent Application No. 61/112,441, filed Nov. 7, 2008, entitled“Zero-Profile Interbody Spacer and Coupled Plate Assembly” and U.S.Provisional Patent Application No. 61/139,920, filed Dec. 22, 2008,entitled “Screw and Plate Locking Mechanisms for Smaller Bone Plates”,the contents of which are hereby incorporated by reference in theirentirety.

BACKGROUND OF THE INVENTION

Intervertebral implants including interbody spacer portions andmechanically coupled plate portions are known in the art for restoringdisc height, allowing fusion to occur between the adjacent vertebralbodies, and for providing stable fixation during healing.

It is desirable to construct a zero-profile implant wherein the bonefixation elements that secure the implant to the vertebral bodies areblocked from backing-out of the bone and/or plate. Additionally, it isdesirable to construct a zero-profile implant that includes polyaxialbone fixation element couplings and features that prevent the implantfrom being implanted too deeply into a prepared disc space. Both screwback-out and over-insertion of the implant into a prepared disc spacecan have an adverse impact on the performance of the implant.

BRIEF SUMMARY OF THE INVENTION

The present invention relates generally to a spinal implant. Morespecifically, the present invention relates to a zero profile interbodyspacer and coupled plate assembly for insertion into a disc spacebetween adjacent superior and inferior vertebral bodies. Preferably, theimplant is sized and configured for use in the cervical region of thespine, where a very limited amount of space is available.

The implant preferably includes a spacer portion, a plate portioncoupled to the spacer portion, a plurality of bone fixation elements forengaging the vertebral bodies and a retention mechanism for preventingthe bone fixation elements from postoperatively uncoupling from theimplant.

The spacer portion preferably includes a top surface for contacting thesuperior vertebral body, a bottom surface for contacting the inferiorvertebral body, a first side surface, a second side surface, a leadingsurface and a trailing surface. The plate portion includes a topsurface, a bottom surface, a first side surface, a second side surface,a leading surface, a trailing surface and one or more bone fixationholes for receiving the one or more bone fixation elements. Preferably,the implant includes at least two bone fixation holes for receiving atleast two bone fixation elements. The first bone fixation hole is angledso that the first bone fixation element engages the superior vertebralbody while the second bone fixation hole is angled so that the secondbone fixation element engages the inferior vertebral body.

The retention mechanism may be in the form of any of the numerousretention mechanisms disclosed herein. The retention mechanism generallyoperates to engage or block subsequent movement of the bone fixationelements in order to prevent the bone fixation elements from backing-outof the bone fixation holes formed in the plate portion (e.g., frompostoperatively uncoupling from the implant).

The implant preferably also includes one or more stops, more preferablyfirst and second stops, to prevent over-insertion of the implant duringimplantation and to assist in securing a position of the implant duringinsertion of the bone fixation elements. The first stop preferablyextends superiorly of the top surface of the plate portion forcontacting the superior vertebral body while the second stop extendsinferiorly of the bottom surface of the plate portion for contacting theinferior vertebral body. The first and second stops are preferablyintegrally formed with the plate portion.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofpreferred embodiments of the application, will be better understood whenread in conjunction with the appended drawings. For the purposes ofillustrating the implant of the present application, there is shown inthe drawings preferred embodiments. It should be understood, however,that the application is not limited to the precise arrangements andinstrumentalities shown. In the drawings:

FIG. 1 illustrates an anterior perspective view of an implant accordingto a first preferred embodiment of the present application;

FIGS. 2A-2E illustrate various perspective views of an implant accordingto a second preferred embodiment, the implant being inserted into anintervertebral disc space between adjacent vertebral bodies via anexemplary implant inserter instrument.

FIG. 3A illustrates an anterior perspective view of an implant accordingto a third preferred embodiment of the present application;

FIG. 3B illustrates an anterior perspective view of the implant of FIG.3A with a blocking plate retention mechanism coupled thereto;

FIG. 4A illustrates an anterior perspective view of an implant accordingto a fourth preferred embodiment of the present application;

FIG. 4B illustrates an anterior perspective view of the implant of FIG.4A with a blocking plate retention mechanism coupled thereto;

FIGS. 5A-5D illustrate various perspective views of additional blockingplate geometries and securing mechanisms;

FIG. 6A illustrates an anterior perspective view of an implant accordingto a fifth preferred embodiment of the present application;

FIG. 6B illustrates an anterior elevational view of the implant of FIG.6A;

FIG. 6C illustrates a perspective view of the retention mechanism of theimplant of FIG. 6A;

FIG. 7 illustrates a partial anterior perspective view of an implantaccording to a sixth preferred embodiment of the present application,the implant incorporating first and second stops;

FIG. 8 illustrates an alternate anterior perspective view of the implantof FIG. 7, the implant incorporating first, second, third and fourthstops;

FIG. 9A illustrates an anterior perspective view of an implant accordingto a seventh preferred embodiment of the present application;

FIG. 9B illustrates an anterior elevational view of the plate portion ofthe implant of FIG. 9A;

FIG. 9C illustrates a side elevational view of the bone fixation elementof the implant of FIG. 9A;

FIG. 10 illustrates a partial cross-sectional view of a plate portion, abone fixation element and a retention mechanism of an implant accordingto an eighth preferred embodiment of the present invention;

FIG. 11 illustrates a partial cross-sectional view of a plate portion, abone fixation element and a retention mechanism of an implant accordingto a ninth preferred embodiment of the present invention;

FIG. 12 illustrates a partial cross-sectional view of a plate portion, abone fixation element and a retention mechanism of an implant accordingto a tenth preferred embodiment of the present invention;

FIG. 13 illustrates a cross-sectional view of an implant according to aneleventh preferred embodiment of the present invention;

FIG. 14A illustrates a partial cross-sectional elevational view of aplate portion, a bone fixation element and a retention mechanism of animplant according to a twelfth preferred embodiment of the presentinvention;

FIG. 14B illustrates an elevational view of the retention mechanism ofthe implant of FIG. 14A, the retention mechanism being illustrated in adeformed, reduced configuration;

FIG. 15 illustrates a partial cross-sectional view of a plate portion, abone fixation element and a retention mechanism of an implant accordingto a thirteenth preferred embodiment of the present invention;

FIG. 16A illustrates an elevational view of a retention mechanism of animplant according to a fourteenth preferred embodiment, the retentionmechanism being illustrated in an open, enlarged configuration;

FIG. 16B illustrates an elevational view of the retention mechanism ofFIG. 16A, the retention mechanism being illustrated in a closed, biasedconfiguration;

FIG. 17 illustrates a partial perspective view of a plate portion, abone fixation element and a retention mechanism of an implant accordingto a fifteenth preferred embodiment of the present invention;

FIG. 18 illustrates a partial cross-sectional view of a plate portion, abone fixation element and a retention mechanism of an implant accordingto a sixteenth preferred embodiment of the present invention;

FIG. 19A illustrates a partial cross-sectional view of a plate portion,a bone fixation element and a retention mechanism of an implantaccording to a seventeenth preferred embodiment of the presentinvention;

FIG. 19B illustrates an alternate partial cross-sectional view of aplate portion, a bone fixation element and a retention mechanism of theimplant of FIG. 19A;

FIG. 19C illustrates an alternate partial cross-sectional view of a bonefixation element and a retention mechanism of the implant of FIG. 19A;

FIG. 19D illustrates a side elevational view of a bone fixation elementand a retention mechanism of the implant of FIG. 19A;

FIG. 20A illustrates a partial anterior, perspective view of a plateportion, a bone fixation element and a retention mechanism of an implantaccording to an eighteenth preferred embodiment of the presentinvention;

FIG. 20B illustrates a cross-sectional view of the bone fixationelements and retention mechanism of the implant of FIG. 20A;

FIG. 20C illustrates an alternate partial anterior, perspective view ofa plate portion, a bone fixation element and a retention mechanism ofthe implant of FIG. 20A;

FIG. 21 illustrates a partial cross-sectional elevational view of aplate portion, a bone fixation element and a retention mechanism of animplant according to a nineteenth preferred embodiment of the presentinvention;

FIG. 22 illustrates a partial cross-sectional elevational view of aplate portion, a bone fixation element and a retention mechanism of animplant according to a twentieth preferred embodiment of the presentinvention;

FIG. 22A illustrates an alternate partial cross-sectional elevationalview of a plate portion, a bone fixation element and a retentionmechanism of the implant of FIG. 22;

FIG. 23A illustrates a cross-sectional view of a bone fixation elementand a retention mechanism of an implant according to a twenty-firstpreferred embodiment of the present invention, the bone fixation elementand retention mechanism being illustrated in a first insertionconfiguration;

FIG. 23B illustrates a cross-sectional view of the bone fixation elementof FIG. 23A, the bone fixation element being illustrated in a secondinserted configuration;

FIG. 24A illustrates a partial anterior view of a plate portion, a bonefixation element and a retention mechanism of an implant according to atwenty-second preferred embodiment of the present invention, the bonefixation element and retention mechanism being illustrated in a firstinsertion configuration;

FIG. 24B illustrates a partial anterior view of the bone fixationelement and retention mechanism of FIG. 24A, the bone fixation elementbeing illustrated in a second inserted configuration;

FIGS. 25A-25C illustrate various views of a bone fixation element and aretention mechanism of an implant according to a twenty-third preferredembodiment of the present invention;

FIG. 26 illustrates a partial cross-sectional view of a plate portion, abone fixation element and a retention mechanism of an implant accordingto a twenty-fourth preferred embodiment of the present invention;

FIG. 27 illustrates a partial anterior perspective view of a plateportion, a bone fixation element and a retention mechanism of an implantaccording to a twenty-fifth preferred embodiment of the presentinvention;

FIG. 28 illustrates a cross-sectional elevational view of a spacerportion, a plate portion, a bone fixation element and a retentionmechanism of an implant according to a twenty-sixth preferred embodimentof the present invention;

FIG. 29 illustrates a partial cross-sectional elevational view of aspacer portion, a plate portion, a bone fixation element and a retentionmechanism of an implant according to a twenty-seventh preferredembodiment of the present invention;

FIG. 30 illustrates an anterior elevational view of a plate portion anda retention mechanism of an implant according to a twenty-eightpreferred embodiment of the present invention;

FIG. 31A illustrates a cross-sectional elevational view of a spacerportion, a plate portion, a bone fixation element and a retentionmechanism of an implant according to a twenty-ninth preferred embodimentof the present invention; and

FIG. 31B illustrates a partial anterior elevational view the plateportion and the retention mechanism of the implant of FIG. 31A.

DETAILED DESCRIPTION OF THE INVENTION

Certain terminology is used in the following description for convenienceonly and is not limiting. The words “right”, “left”, “lower” and “upper”designate directions in the drawings to which reference is made. Thewords “inwardly” or “distally” and “outwardly” or “proximally” refer todirections toward and away from, respectively, the geometric center ofthe implant and related parts thereof. The words, “anterior”,“posterior”, “superior,” “inferior” and related words and/or phrasesdesignate preferred positions and orientations in the human body towhich reference is made and are not meant to be limiting. Theterminology includes the above-listed words, derivatives thereof andwords of similar import.

Similar reference numerals will be utilized throughout the applicationto describe similar or the same components of each of the preferredembodiments of the implant described herein and the descriptions willfocus on the specific features of the individual embodiments thatdistinguish the particular embodiment from the others.

Preferred embodiments of the present application are directed to animplant 10-2800. It should be understood that while the variousembodiments of the implant 10-2800 will be described in connection withspinal surgery, those skilled in the art will appreciate that theimplant 10-2800, as well as the components thereof, may be used forimplantation into other parts of the body, including, for example, longbones or bones in the knee, hip, shoulder, or other joint replacement orfor bone augmentation.

The various embodiments of the implant 10-2800 are preferably sized andconfigured to be implanted between adjacent vertebral bodies V. Theimplant 10-2800 may be sized and configured to replace all orsubstantially all of an intervertebral disc space D between adjacentvertebral bodies V or only part of the intervertebral disc space D. Inaddition, the preferred implant 10-2800 may be configured to replace anentire vertebral body V and related disc spaces D or multiple discspaces D in a patient's spine, as would be apparent to one havingordinary skill in the art based upon a review of the presentapplication. The implant 10-2800 may be adapted for use in the anterior,anterolateral, direct lateral, extra-foraminal, transforaminal, andposterior approaches for insertion into the spine.

The implant 10-2800 of each of the preferred embodiments includes aninterbody spacer portion 20-2820 and a plate portion 50-2850. The spacerportion 20-2820 is preferably sized and configured for implantation intothe intervertebral disc space D between adjacent vertebral bodies V. Thespacer portion 20-2820 of each of the preferred embodiments includes atop surface 22, a bottom surface 24, a first side surface 26, a secondside surface 28, a leading surface 30 and a trailing surface 32. The topand bottom surfaces 22, 24 are suitable for contacting and are adaptedfor being secured relative to the end plates of adjacent vertebralbodies V. The spacer portion 20-2820 is preferably sized and configuredto maintain and/or restore a desired intervertebral disc height betweenthe adjacent vertebral bodies V. Accordingly, the top and bottomsurfaces 22, 24 may include a series of teeth, ridges, spikes or othersimilar projections 25 to aid in securing the implant 10-2800 to theendplates of the adjacent vertebral bodies V.

The top and bottom surfaces 22, 24 may also include a curved or atapered surface to help provide an anatomical shape for mating with thepatient's spine or to orient the endplates of the adjacent vertebralbodies V in a desired manner. The particular surface shape andcurvature, taper or alternate surface feature in the anterior-posteriordirection, as well as the particular surface shape and curvature, taperor alternate surface feature in the medial-lateral direction will dependupon the location where the implant 10-2800 is intended to be implantedand/or surgeon preferences or whether the implant 10-2800 is utilized inanother area in the body.

The spacer portion 20-2820 may also include one or more boreholes,openings, windows or channels for receiving bone graft material. Forexample, the implant 10-2800 may include one or more vertical openings,windows or channels extending through the spacer portion from the topsurface 22 to the bottom surface 24 for insertion of bone graftmaterial, such that bone growth is promoted through the verticalopenings, windows or channels following implantation of the implant10-2800. One or more boreholes, openings, windows or channels isespecially preferred if the spacer portion 20-2820 is constructed of anon-allograft or non-bone-growth material, such as Polyetheretherketone(“PEEK”).

The plate portion 50-2850 is preferably coupled to the spacer portion20-2820 to provide increased implant stability during healing as well asto optimally orient the trajectory of bone fixation elements 70 duringimplantation.

The plate portion 50-2850 of each of the preferred embodiments includesa top surface 52, a bottom surface 54, a first side surface 56, a secondside surface 58, a leading surface 60 and a trailing surface 62. Theplate portion 50-2850 preferably contacts the trailing surface 32 of thespacer portion 20-2820 and preferably does not extend beyond or does notincrease greatly the vertical or lateral perimeter of the spacer portion20-2820. In this manner, the implant 10-2800 has a low profile.Additionally, in this manner, the plate portion 50-2850 is preferablyentirely implanted within the intervertebral disc space D between theadjacent vertebral bodies V such that the plate portion 50-2850 haslittle or no external profile (e.g., the plate portion 50-2850 does notextend anterior beyond an edge of the disc space D). In this manner,little or no structure protrudes outside of the bounds of the disc spaceD or the profile of the vertebral bodies V, thereby limiting dysphasiaand patient discomfort. In use, the plate portion 50-2850 may be sizedand configured so that the top and bottom surfaces 52, 54 of the plateportion 50-2850 contact the endplates of the adjacent vertebral bodiesV. Alternatively, the plate portion 50-2850 may be sized and configuredso that only the spacer portion 20-2820 contacts the adjacent vertebralbodies V. For example, the height of the plate portion 50-2850 may besmall enough so that it does not contact the vertebral bodies V whenconnected to the spacer portion 20-2820 in an implanted position.

The plate portion 50-2850 may be coupled to the spacer portion 20-2820by any coupling mechanism now or hereafter known. For example, thespacer portion 20-2820 may include one or more recesses 36 formed in theside or trailing surfaces for engaging one or more projections 64extending from the plate portion 50-2850. Preferably the spacer portion20-2820 includes a recess 36 formed in each of the side surfaces 26, 28thereof for engaging projections 64 extending from the plate portion50-2850. The recesses 36 may extend completely from the top surface 22to the bottom surface of the spacer portion 20-2820 or may extend onlypartially from either the top or bottom surface 20, 22. Other couplingmechanisms for coupling the plate portion 50-2850 to the spacer portion20-2820 are disclosed in International Application No. PCT/US2008/082473filed on Nov. 5, 2008 and entitled, “Low Profile IntervertebralImplant”, the contents of which are hereby incorporated by reference intheir entirety.

The trailing surface 62 of the plate portion 50-2850 preferably includesa tool engagement feature (not shown) for engaging one or more insertiontools. The tool engagement feature may be in any form now or hereafterknown for such purpose including one or more recesses (not shown) formedin the trailing surface 62 of the plate portion 50-2850, the recessesextending from top and bottom surfaces 52, 54, respectively, forengaging arms of the insertion tool (not shown). Alternatively, the toolengagement feature may be a threaded bore (not shown) formed in thetrailing surface 62 of the plate portion 50-2850 for engaging a threadedstem extending from the insertion tool, etc.

The implant 10-2800 preferably includes one or more bone fixation holes40 for receiving one or more bone fixation elements 70, preferably bonescrews so that, in use, after the implant 10-2800 has been inserted intothe intervertebral disc space D between adjacent vertebral bodies V, theimplant 10-2800 may be secured to the adjacent vertebral bodies V. Thebone fixation elements 70 preferably include a threaded shaft 72 and apartially spherical head portion 74 that is generally smooth where itcontacts the bone fixation hole 40. The threaded shaft 72 may beself-drilling, i.e. does not necessitate the drilling of pilot holes,but are not so limited. The bone fixation elements 70 are not limited tobone screws 70 and may be comprised of a helical nail, a distallyexpanding nail or screw, etc. The bone fixation holes 40 are preferablysized and configured so that the head portion 74 of the bone fixationelements 70 do not protrude proximally beyond the trailing surface 62 ofthe plate portion 50, when the bone fixation elements 70 have been fullyimplanted.

The bone fixation holes 40 preferably include a curved orfrusta-spherical surface for contacting an underside of the generallysmooth or frustaspherical surface of the head portion 74 of the bonefixation elements 70 so that the bone fixation elements 70 canpolyaxially rotate with respect to the plate portion 50-2850 and avariety of trajectory angles can be chosen for the bone fixationelements 70 according to surgeons' preferences or needs as well as toenable the implant 10-2800 to settle during healing. Post implantation,the bone fixation elements 70 are preferably free to toggle to allow forsettling during postoperative healing. If a surgeon decides theplacement of the implant 10-2800 is not optimal, adjustments can be madeby moving the retention mechanism (as will be described in greaterdetail below) with, for example a blunt instrument, to allow the bonefixation elements 70 to be removed.

The plate portion 50-2850 preferably includes at least first and secondbone fixation holes 40 for receiving at least first and second bonefixation elements 70 with the first bone fixation element 70 beingangled upwardly for engaging the superior vertebral body V and thesecond bone fixation element 70 being angled downwardly for engaging theinferior vertebral body V. That is, the bone fixation holes 40preferably have a longitudinal axis that is oriented obliquely withrespect to the implant 10-2800 so that the bone fixation elements 70form a fastener angle with respect to the top and bottom surfaces 22, 24of the spacer portion 20-2820 wherein bone fixation angle may be in therange between twenty degrees (20°) and sixty degrees (60°), and morepreferably between thirty degrees (30°) and fifty degrees (50°). Thebone fixation angle may be the same for all of the holes 40 or may bedifferent for each of the holes 40. In addition, the bone fixation holes40 may be directed inwardly toward the center of the implant 10-2800oroutwardly away from the center of the implant 10-2800, preferably at alateral bone fixation angle α so that the bone fixation elements 70extend laterally inward toward a center plane of the implant 10-2800 orlaterally outward away from the center plane of the implant 10-2800. Thelateral bone fixation angle α may be in the range between plus sixtydegrees (60°) and minus sixty degrees)(−60°, preferably between zerodegrees (0°) and plus or minus thirty degrees (30°), and more preferablyabout plus or minus fifteen degrees (15°). The lateral bone fixationangle α may be the same for all holes 40 or may be different for eachhole 40. However, as would be understood by one of ordinary skill in theart based upon a reading of this disclosure, a plurality of potentialangles is possible since the bone fixation elements 70 are polyaxial, aswill be described in greater detail below.

It should be understood however that the implant 10-2800 may include anynumber of bone fixation holes 40 configured to receive a correspondingnumber of bone fixation elements 70 in any number of configurations. Inaddition, the number of bone fixation elements 70 extending from the topand bottom surfaces 22, 24 may be varied and the number of bone fixationelements 70 extending from the top surface 22 need not equal the numberof bone fixation elements 70 extending from the bottom surface 24.

Exit openings for the bone fixation holes 40 preferably are formed atleast partially in the top or bottom surfaces 52, 54 of the plateportion 50-2850. The exit openings may also be formed at least partiallyor entirely in the top or bottom surfaces 22, 24 of the spacer portion20-2820. The bone fixation holes 40 may also include a partiallyspherical interior volume to accommodate the partially sphericalgeometry of the head portion 74 of the bone fixation elements 70 toenable a range of polyaxial orientations to be chosen for the bonefixation elements 70 with respect to the vertebral bodies V.

The implant 10-2800 preferably includes a retention mechanism forreducing the likelihood that the bone fixation elements 70 maypostoperatively uncouple from the implant 10-2800 and migrate from thedisc space D. In use, the retention mechanism preferably engages orcontacts the bone fixation element 70 or blocks or covers at least aportion of the bone fixation holes 40 and hence the bone fixationelements 70 to prevent the bone fixation elements 70 from backing-out,as will be described in greater detail below.

The implant 10-2800 including the spacer portion 20-2820 and the plateportion 50-2850 may be constructed of any suitable biocompatiblematerial or combination of materials including, but not limited to oneor more of the following metals such as titanium, titanium alloys,stainless steel, aluminum, aluminum alloy, magnesium, etc., polymerssuch as, PEEK, porous PEEK, carbon fiber PEEK, resorbable polymers,PLLA, etc., allograft, synthetic allograft substitute, ceramics in theform of bioglass, tantalum, Nitinol, or alternative bone growth materialor some composite material or combination of these materials.

The spacer portion 20-2820 may be formed of a different material thanthe plate portion 50-2850. For example, the plate portion 50-2850 may beformed of a metallic material such as, a titanium or a titanium alloy,and the spacer portion 20-2820 may be formed of a non-metallic materialsuch as, a polymer such as, PEEK, an allograft, a bioresorbablematerial, a ceramic, etc. Alternatively, the plate portion 50-2850 andthe spacer portion 20-2820 may be formed from the same material. Inaddition, the plate portion 50-2850 and spacer portion 20-2820 may beintegrally formed, pre-assembled or separately provided to a surgeon andassembled in the operating room.

As will be appreciated by one of ordinary skill in the art, the implant10-2800, or portions thereof, may also be coated with various compoundsto increase bony on-growth or bony in-growth, to promote healing or toallow for revision of the implant 10-2800, including hydroxyapatite,titanium-nickel, vapor plasma spray deposition of titanium, or plasmatreatment to make the surface hydrophilic.

Referring to FIG. 1, the intervertebral implant 10 of a first preferredembodiment includes the interbody spacer portion 20, the plate portion50, first, second and third bone fixation elements 70 and the retentionmechanism. In the first preferred embodiment, the retention mechanism isin the form of a retaining clip 80 coupled to the plate portion 50 via ablocking plate 82. Alternatively, the implant 10 may include a pluralityof retaining clips 80 coupled to the plate portion 50 via the blockingplate 82. The retaining clip 80 is preferably coupled to the blockingplate 82 before the blocking plate 82 is coupled to the plate portion50.

The blocking plate 82 preferably includes a pair of elasticallydeflectable spring fingers 84 extending distally therefrom for engagingcorresponding recesses formed in the side surfaces 56, 58 of the plateportion 50. The blocking plate 82 preferably is sized and configured tosnap over the trailing surface 62 of the plate portion 50 so that, inoperation, the retaining clip 80 is coupled to the blocking plate 82 andthe blocking plate 82 and the retaining clip 80 assembly is coupled to,e.g., snapped over, the trailing surface 62 of the plate portion 50. Theimplant 10 is then inserted into the disc space D and the bone fixationelements 70 are inserted. Alternatively, the blocking plate 82 and theretaining clip 80 assembly may be coupled to the plate portion 50subsequent to the insertion of the bone fixation elements 70 through theboreholes 40 formed in the plate portion 50. Alternatively, a variety ofother now or hereafter developed coupling mechanisms may be used forcoupling the blocking plate 82 to the plate portion 50 includingsnap-locks, screw(s) and borehole(s), etc.

Referring to FIGS. 2A-2E, the intervertebral implant 100 of a secondpreferred embodiment includes the spacer portion 120, the plate portion150, first and second bone fixation elements (not shown) and theretention mechanism. In the second preferred embodiment, the retentionmechanism is in the form of an externally threaded retaining screw 180,a threaded borehole 185 formed in the plate portion 150 preferablybetween the bone fixation holes 40 and a blocking plate 190 forcovering, contacting and/or interacting with at least a portion of thefirst and second bone fixation elements to block the first and secondbone fixation elements and limit the first and second bone fixationelements from backing-out of the bone fixation holes 40.

The implant 100 may further include an implant inserter instrument 195including an inner shaft 196 having a set of external threads 197protruding from a distal end thereof for threadably engaging thethreaded borehole 185 formed in the plate portion 150 of the implant100. The implant inserter instrument 195 preferably also includes anouter tubular member 198 housed concentrically around the inner shaft196 and configured to enable the inner shaft 196 to rotate with respectthereto.

The implant inserter instrument 195, and more particularly, the outertubular member 198 preferably includes one or more stops 199 forpreventing over-insertion of the implant 100. More preferably, theimplant inserter instrument 195 includes first and second stops 199, thefirst stop 199 protruding superiorly for contacting the superiorvertebral body V while the second stop 199 protrudes inferiorly forcontacting the inferior vertebral body V. Incorporation of more or lessstops 199 is envisioned. Incorporation of the first and second stops 199facilitates fully seating the implant 100 with respect to the adjacentvertebral bodies V regardless of the irregular anatomy of a patient'sspine, which often characterizes the outer surface of the vertebralbodies V.

In use, the stops 199 are configured to abut the anterior aspects of thevertebral bodies V during implantation, although the stops 199 may abutthe lateral or antero-lateral aspects of the vertebral bodies Vdepending upon the surgical procedure and insertion path being utilized.The stops 199 assist in preventing over-insertion of the implant 100during implantation and assist in securing the position of the implant100 during insertion of the bone fixation elements, as will be describedin greater detail below.

In operation, the implant inserter instrument 195 is coupled to theimplant 100 via threadably mating the threads 197 formed on the distalend of the inner shaft 196 with the threaded borehole 185 formed in theplate portion 150. The implant inserter instrument 195 is then used toinsert the implant 100 into the disc space D between the adjacentvertebral bodies V until the stops 199 abut the anterior (or lateral orantero-lateral) aspects of the vertebral bodies V. The first and secondbone fixation elements are then inserted through the boreholes 40 andinto the vertebral bodies V while lagging of the implant 100 is limitedby interaction of the stops 199 with the anterior aspects of thevertebral bodies V. That is, advancement of the bone fixation elementsinto the bone fixation holes 40 causes the head portion of the bonefixation elements to contact the inner spherical portions of the bonefixation holes 40 and tends to draw the vertebral bodies V intoalignment as opposed to resulting in the over-insertion of the implant100 since the stops 199 guide the movement of the vertebral bodies Vduring bone fixation manipulation. That is, because the stops 199contact the adjacent vertebral bodies V and prevents over-insertion ofthe implant 100 into the disc space D, advancement of the bone fixationelements tends to pull and/or reposition the adjacent vertebral bodies Vtogether to promote fusion.

The position of the implant 100 can be adjusted with respect to the discspace D by rotating the inner shaft 196, e.g., by rotating a handleportion of the inner shaft 196. The bone fixation elements are insertedthrough the boreholes 40 and into the vertebral bodies V, while theimplant inserter instrument 195 remains coupled to the implant 100 suchthat the stops 199 remain abutted to the anterior aspects of thevertebral bodies V to limit movement of the implant 100 while the bonefixation elements are being inserted. The implant inserter instrument195 may then be decoupled from the implant 100 and the blocking plate190 may be coupled to the plate portion 150 via the retaining screw 180to block the bone fixation elements from backing-out.

Referring to FIGS. 3A and 3B, the intervertebral implant 200 of a thirdpreferred embodiment includes the interbody spacer portion 220, theplate portion 250, first, second and third bone fixation elements 70 andthe retention mechanism. In the third preferred embodiment, theretention mechanism includes a blocking plate 280 having a pair ofelastically deflectable spring fingers 284 extending distally therefromfor engaging corresponding recesses 286 formed in the side surfaces 56,58 of the plate portion 250. The blocking plate 280 is preferably sizedand configured to snap over the trailing surface 62 of the plate portion250 so that, in operation, the blocking plate 280 may be coupled to theplate portion 250 subsequent to the insertion of the bone fixationelements 70 to limit back-out of the bone fixation elements 70.

Referring to FIGS. 4A and 4B, the intervertebral implant 300 of a fourthpreferred embodiment includes the interbody spacer portion 320, theplate portion 350, first, second and third bone fixation elements 70 andthe retention mechanism. In the fourth preferred embodiment, theretention mechanism includes a blocking plate 380 having a plurality ofelastically deflectable spring fingers 384 extending distally therefromfor engaging corresponding recesses or indentations 386 formed in theplate portion 350. More preferably, the recesses or indentations 386 areformed within the bone fixation holes 40 formed in the plate portion350. The blocking plate 380 is sized and configured to snap onto thetrailing surface 62 of the plate portion 350 so that, in operation, theblocking plate 380 is operatively coupled to the plate portion 350subsequent to the insertion of the bone fixation elements 70 to limitback-out of the bone fixation elements 70.

It should be understood that additional blocking plate geometries andsecuring mechanisms are envisioned. For example, referring to FIGS.5A-5D, a variety of additional blocking plate geometries and securingmechanisms 380′, 380″, 380′″, 380″″ are provided for use with thepreferred implant assemblies and their configuration and operation willbe apparent to one having ordinary skill in the art from theabove-listed descriptions of the implants, assemblies and blockingplates. The additional blocking plate configurations may be constructedof rigid or flexible materials and may be coupled to the plate portionsbefore or after insertion of the bone fixation elements.

Referring to FIGS. 6A-6C, the intervertebral implant 400 of a fifthpreferred embodiment includes the interbody spacer portion 420, theplate portion 450, first, second and third bone fixation holes 40 forreceiving first, second and third bone fixation elements (not shown) andthe retention mechanism. In the fifth preferred embodiment, theretention mechanism includes first, second and third unidirectionalretaining clips 480 positioned inside the first, second and third bonefixation holes 40. The retaining clips 480 are preferably in the form ofa wishbone clip formed of, for example, elgiloy, although other shapesand material are envisioned. The retaining clips 480 are mounted in thebone fixation holes 40 to assist in securing the bone fixation elementsto the plate portion 450 by allowing insertion of the bone fixationelements into the holes 40 while preventing the bone fixation elementsfrom backing-out of the holes 40. That is, the retaining clips 480preferably permit unidirectional advancement of the head portion of thebone fixation elements distally into the bone fixation holes 40 andthrough the retaining clip 480 while limiting backing-out of the bonefixation elements by blocking its regression once the head portion haspassed through the retaining clip 480.

In operation, the partially spherical head portion of the bone fixationelements passes distally into the bone fixation holes 40 and through theretaining clip 480 such that the tapered or partially sphericalunderside of the head portion of the bone fixation elements bear againstthe retaining clips 480 thereby urging the arms 481 a, 481 b of theretaining clips 480 to flex outwardly a slight amount to permit passageof the head portion therethrough.

Once the head portion of the bone fixation element has fully passedthrough the retaining clip 480, the arms 481 a, 481 b of the retainingclip 480 spring back to their original configuration, thereby coveringand/or blocking the head portion of the bone fixation element. The bonefixation element is thereby prevented from backing-out due to thenon-tapered (partially flat) aspect of the proximal surface of the headportion of the bone fixation element, which generally prevents the bonefixation element from passing back through the retaining clip 480. Theretaining clip 480 may be manually flexed open by a tool to permitremoval of the bone fixation elements from the implant 400, if desired.

Alternatively, the retention mechanism may take on any other form thatfacilitates unidirectional advancement of the bone fixation elementswhile limiting backing-out of the bone fixation elements. For example,the retention mechanism may be in the form of a blocking mechanism. Forexample, the plate portion 450 may be formed from a polymer such as PEEKand the retention mechanism may include one or more blocking mechanismsformed from a metal such as titanium. In use, the blocking mechanism ispreferably disposed within the bone fixation hole 40 formed in the plateportion 450 and is configured in such a way as to enable deformation ofthe blocking mechanism to allow the head portion of the bone fixationelement to pass beyond the blocking mechanism. Once the head portion ofthe bone fixation element passes beyond the blocking mechanism, theblocking mechanism elastically return to its original shape to blockand/or cover the head portion of the bone fixation element frombacking-out from the plate portion 450. The polymeric plate portion 450can be injection molded onto or around the blocking mechanism(s). Theblocking mechanism can be any one of a number of configurations so longas the blocking mechanism deforms to enable the bone fixation element topass therethrough and then radially expands to block and/or cover atleast a portion of the bone fixation element. The blocking mechanism canbe configured to block and/or cover a single bone fixation element or aplurality of bone fixation elements.

Referring to FIG. 7, the intervertebral implant 500 of a sixth preferredembodiment includes the interbody spacer portion 520, the plate portion550, first and second bone fixation elements 70 and the retentionmechanism. In the sixth preferred embodiment, the retention mechanismincludes an unidirectional retaining clip 580 disposed in a recess 582,such as a blind borehole, formed in the plate portion 550 between thebone fixation holes 40. In use, a portion of the retaining clip 580protrudes from the recess 582 into each of the bone fixation holes 40 tocover and/or block the head portions 74 of the bone fixation elements 70in an implanted position. The retaining clip 580 preferably permitsunidirectional advancement of the head portions 74 of the first andsecond bone fixation elements 70 distally into the bone fixation holes40 and past the retaining clip 580 to limit backing-out of the bonefixation elements 70 by covering and/or blocking their regression oncethe head portions 74 of the bone fixation elements 70 have advanced pastthe retaining clip 580. The retaining clip 580 is otherwisesubstantially identical in operation to the retaining clip 480 discussedabove.

It should be noted that while the retaining clip 580 is shown as havingan S-shape on its side and retaining clip 480 is shown as having awishbone shape, it is envisioned that a range of applicable geometriescan be used. For example, retaining clip 580 may have a wishbone shapewherein a portion of each arm protrudes into each bone fixation hole 40.Accordingly, the retaining clips 480, 580 may have nearly any shapeand/or configuration that permits engagement with the plate portion 450,550, flexure out of the bone fixation holes 40 as the head portion 74 ofthe bone fixation elements 70 passes therethrough and spring back atleast partially into the bone fixation holes 40 once the head portion 74passes the retaining clip 480, 580.

Referring to FIG. 7, the implant 500, and any other implant 10-2800described herein, may also incorporate one or more stops 99 that arepreferably integrally formed on the plate portion 550. The stops 99 areconfigured to abut the anterior (or lateral or antero-lateral) aspectsof the vertebral bodies V during implantation. In operation, the stops99 assist in preventing over-insertion of the implant 500 duringinsertion into the disc space D and assist in securing the position ofthe implant 500 during insertion of the bone fixation elements 70.

As shown in FIG. 7, the implant 500 may include first and second stops99 a, 99 b. Incorporation of first and second stops 99 a, 99 b isdesirable in circumstances where it is difficult to fully seat theimplant 500 due to an irregular anatomy of the patient's spine, whichoften characterizes the anterior (or lateral or antero-lateral) aspectsof the vertebral bodies V. Due to the disposition of the stops 99, theimplant 500 generally has a zero-profile external to the disc space D atleast along a cranial-caudal midline, because the trailing surface 62 ofthe plate portion 550 can be designed to be convex to match the discspace D. The distal surfaces of the stops 99 can be configured to embedat least partially into the vertebral bodies V during impaction tofurther reduce the profile of the plate portion 550 exterior to the discspace D, if so desired. For example, the distal surface of the stops 99may include one or more pyramid shaped projections, teeth, blades, etc.extending therefrom for embedding at least partially into the vertebralbodies V during impaction. Alternatively, as shown in FIG. 8, theimplant may include four stops 99 a-99 d disposed at or near the fourcorners of the plate portion. It is envisioned that the implant mayinclude any number of stops 99 in any configuration.

Referring to FIGS. 9A-9C, the intervertebral implant 600 of a seventhpreferred embodiment includes the interbody spacer portion 620, theplate portion 650, first and second bone fixation elements 70′ and theretention mechanism. In the seventh preferred embodiment, the retentionmechanism includes forming scallop-shaped threaded regions 41′ on theinner surface of the bone fixation holes 40′ for engaging externalthreads 74 a′ formed on the head portions 74′ of the bone fixationelements 70′. In operation, the partially threaded scallop-shaped bonefixation holes 40′ mate with the exterior threading 74 a′ formed on thehead portions 74′ of the bone fixation elements 70′ to permit variableangle orientation of the bone fixation elements 70′ with respect to theplate portion 650 as well as provide an interference fit between thehead portions 74′ of the bone fixation elements 70′ and the interior ofthe bone fixation holes 40′ to reduce the likelihood of backing-out. Thegeometry of the bone fixation holes 40′ further enable a variety ofdifferent screw sizes and styles (variable angle screws, locking screws,locking variable angle screws, etc.) to be utilized in conjunction withthe implant 600.

Referring to FIG. 10, the intervertebral implant 700 of an eighthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 750, a plurality of bone fixation elements 70 and theretention mechanism. In the eighth preferred embodiment, the retentionmechanism includes a bushing 780 located within the bone fixation holes40. More preferably, the bushing 780 is spring-loaded inside the bonefixation holes 40 formed in the plate portion 750. The bone fixationholes 40 preferably include an undercut or groove 782 for receivingand/or securing the bushing 780 therein. In use, the head portion 74 ofthe bone fixation element 70 bears against the bushing 780 duringinsertion of the bone fixation element 70, causing the bushing 780 toinitially expand and then subsequently to collapse about the headportion 74 to thereby secure the bone fixation element 70 to the plateportion 750. The bushing 780 preferably includes a spherical or curvateouter surface 781 for mating with a corresponding spherical or curvateinner surface formed in the undercut or groove 782 so that the bushing780, and hence the bone fixation element 70, can polyaxial rotate withrespect to the plate portion 750.

Referring to FIG. 11, the intervertebral implant 800 of a ninthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 850, a plurality of bone fixation elements 70 and theretention mechanism. In the ninth preferred embodiment, the retentionmechanism includes a bushing 880 circumferentially disposed around thehead portion 74 or neck portion of the bone fixation element 70. Morepreferably, the bushing 880 is spring-loaded around the head portion 74or neck portion of the bone fixation element 70. The bone fixation hole40 formed in the plate portion 850 preferably includes one or moreprojections 882 protruding therein so that, as the bushing 880 and bonefixation element 70 are advanced into the bone fixation hole 40, thebushing 880 interacts with the one or more projections 882 to compressthe bushing 880. Upon passing the projections 882, the bushing 880radially expands such that the diameter of the bushing 880 is largerthan the diameter of the bone fixation hole 40 as measured at theprojections 882 thereby limiting back-out of the bone fixation element70.

Referring to FIG. 12, the intervertebral implant 900 of a tenthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 950, a plurality of bone fixation elements 70 and theretention mechanism. In the tenth preferred embodiment, the retentionmechanism includes one or more thin-walled projections 980 protrudinginto the bone fixation holes 40. The projections 980 being configured todeform as the bone fixation element 70 is advanced through the bonefixation hole 40. The bone fixation elements 70 preferably including atapered flange 982 and a recess 984 formed on the head portion 74 orneck portion thereof. The flange 982 being configured to expand theprojection 980 as the bone fixation element 70 is advanced through thebone fixation hole 40. Once the bone fixation element 70 is fullyseated, the projection 980 contracts and is received within the recess984 to thereby secure the bone fixation element 70 with respect to theplate portion 950.

Referring to FIG. 13, the intervertebral implant 1000 of an eleventhpreferred embodiment includes the interbody spacer portion 1020, theplate portion 1050, first and second bone fixation elements 70 and theretention mechanism. In the eleventh preferred embodiment, the retentionmechanism includes a plurality of deformable fingers, projections orthinned-walled lip members (collectively “fingers”) 1080 that arepreferably machined into the plate portion 1050 circumferentially aboutthe bone fixation holes 40. Once the bone fixation element 70 isinserted through the bone fixation hole 40, a forceps-like instrument1090 may be used to deform the plurality of fingers 1080 to at leastpartially cover and/or block the head portion 74 of the bone fixationelement 70. The fingers 1080 may be machined to stand proud or lie flushwith respect to the trailing surface 62 of the plate portion 1050 priorto deformation.

Referring to FIGS. 14A and 14B, the intervertebral implant 1100 of atwelfth preferred embodiment includes the interbody spacer portion (notshown), the plate portion 1150, a plurality of bone fixation elements 70and the retention mechanism. In the twelfth preferred embodiment, theretention mechanism includes a spring clip 1180. The clip 1180 ispreferably manufactured from an elastically deformable material so thatthe clip 1180 may be deformed to a reduced configuration. In use, thebone fixation element 70 is inserted into a bone fixation hole 40 formedin the plate portion 1150. The clip 1180 is then preferably deformed viaa grasping or forceps-type instrument 1190 to the reduced configuration.After the bone fixation element 70 has been fully inserted, theinstrument 1190 places the clip 1180 into the interior of the bonefixation hole 40 or a groove (not shown) formed on the trailing surface62 of the plate portion 1150, and releases the spring clip 1180, atwhich point the spring clip 1180 expands and returns to its originalshape, thereby locking to the groove or hole 40 and covering and/orblocking the head portion 74 of the bone fixation element 70.

Referring to FIG. 15, the intervertebral implant 1200 of a thirteenthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 1250, a plurality of bone fixation elements 70″ andthe retention mechanism. In the thirteenth preferred embodiment, thebone fixation elements 70″ are in the form of an expansion-headed screwand the retention mechanism includes a locking screw 1280 couplable toand advanceable within the expansion-head screw 70″. That is, the headportion 74″ of the expansion-head screw 70″ preferably includes aninternally threaded bore 1281 and optional slots (not shown) extendingfrom a proximal end thereof. In use, the locking screw 1280 is actuated,e.g., rotated, into engagement with the internally threaded bore 1281formed in the proximal end of the expansion-head screw 70″ to radiallyexpand the head portion 74″ of the expansion-head screw 70″ to therebylock the expansion-head screw 70″ within the bone fixation hole 40. Thehead portion 74″ may include a partially spherical outer surface formating with a corresponding partially spherical inner surface formed inthe bone fixation hole 40 to enable variable angular placement of theexpansion-head screw 70″ with respect to the plate portion 1250″, aswell as angulation of the screw shaft 72″ with respect to the plateportion 1250 after the screw 70″ is locked to the plate portion 1250.The spherical dimensions of the head portion 74″ of the expansion-headscrew 70″ can be chosen to allow an interference or rigid fit or toallow for a clearance or toggling fit between the expansion-head screw70″ and the plate portion 1250.

Many varieties of blocking plates are used in the art to limit back-outof bone fixation elements 70. Most of these blocking plates utilize anadditional screw, rivet, or pin to secure the blocking plate in place.Referring to FIGS. 16A and 16B, the intervertebral implant of afourteenth preferred embodiment includes the interbody spacer portion(not shown), the plate portion (not shown), a plurality of bone fixationelements (not shown) and the retention mechanism. In the fourteenthpreferred embodiment, the retention mechanism includes a blocking plate1380 formed from an elastic “spring-like” material that preferablyenables the plate 1380 to be manufactured in a biased position. Forexample, the blocking plate 1380 may include a concave or convextrailing surface 1382 (as shown in FIG. 17A) that can be snapped orpopped in the opposite direction by pushing on a center portion 1384 ofthe blocking plate 1380. This snapping movement forces the outside edgesof the blocking plate 1380 to move inwardly or outwardly to increase ordecrease the radius of the blocking plate 1380. The outside edges of theblocking plate 1380 can include fingers 1386 that are mateable withrecesses (not shown) formed on the plate portion (not shown) such that asecure attachment between the blocking plate 1380 and the plate portionis achieved without the inclusion of additional components. Referring toFIG. 17B, applying a force to the center portion 1384 of the blockingplate 1380, when placed appropriately with respect to the plate portion,forces the blocking plate 1380 to pop inside out, increasing its radiusand mating to the plate portion to at least partially cover the headportions 74 of the bone fixation elements 70.

Referring to FIG. 17, the intervertebral implant 1400 of a fifteenthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 1450, a plurality of bone fixation elements 70 and theretention mechanism. In the fifteenth preferred embodiment, the plateportion 1450 and the bone fixation elements 70 are manufactured from apolymer, such as PEEK, so that a welding process can be utilized tosecure the bone fixation elements 70 to the plate portion 1450. That is,for example, the implant 1400 may include a ring 1480 or otherprotrusion inherent on the underside of the head portion 74 of the bonefixation elements 70. The plate portion 1450, the bone fixation elements70 and the ring 1480 each being manufactured from PEEK or similarpolymer. The ring 1480 creates a small surface area for heat orvibration to be transferred therethrough. In use, after the bonefixation elements 70 have been inserted through the plate portion 1450,an ultrasonic vibration or heat is applied to the head portion 74 of thebone fixation element 70 to thereby cause the ring 1480 and itsinterface with the plate portion 1450 to melt and fuse together, therebylocking the bone fixation element 70 to the plate portion 1450. Thecross-sectional area of the ring 1480 adjacent to the plate portion 1450is preferably relatively small to focus the vibrations and/or heat inthese areas and to promote fusing of the ring 1480 to the plate portion1450. Alternatively, the bone fixation element 70 can be a non-threadedpin so that the ultrasonic vibrations can be utilized to drive the pinsinto the bone before welding.

The most common bone fixation element for securing an implant to bone isa bone screw, as is apparent to one having ordinary skill in the art.The threads on the shaft of the bone screw provide purchase, whichallows lagging and fixation. The bone screw is preferably threaded intothe bone by torquing the head of the bone screw. This method of fixationmay be altered by eliminating the threading step and saving surgicaltime and effort. For example, referring to FIG. 18, the intervertebralimplant 1500 of a sixteenth preferred embodiment includes the interbodyspacer portion (not shown), the plate portion 1550, a plurality of bonefixation elements 70′″ and the retention mechanism. In the sixteenthpreferred embodiment, the bone fixation elements 70′″ are in the form ofnon-threaded pins that include one or more projections 1580 extendingfrom the neck or shaft portion of the pin 70′″. The projections 1580preferably are biased to outwardly extend from the neck or shaft portionof the pin 70′″. The projections 1580 are preferably inwardlydeflectable so that the projections 1580 can be advanced through thebone fixation holes 40 formed in the plate portion 1550. In use, oncethe non-threaded pins 70′″ have been fully inserted, the projections1580 expand. The outward expansion of the projections 1580 occursinterior to the bone and/or adjacent to the leading surface 60 of theplate portion 1550 adjacent to the bone fixation hole 40 to secure thepin 70′″ into the bone and/or block the pin 70′″ from backing-out of theplate portion 1550.

Referring to FIGS. 19A and 19B, the intervertebral implant 1600 of aseventeenth preferred embodiment includes the interbody spacer portion(not shown), the plate portion 1650, a plurality of bone fixationelements 70″″ and the retention mechanism. In the seventeenth preferredembodiment, the bone fixation elements 70″″ include a cannulated bore1680 extending from a proximal end thereof. An instrument or mandrel1682 is also provided for insertion into the cannulated bore 1680. Inuse, insertion of the mandrel or instrument 1682 into the cannulatedbore 1680 expands one or more fingers or other expandable members 1684on the shaft or neck portion of the bone fixation element 70″″.Alternatively, insertion of the mandrel or instrument 1682 into thecannulated bore 1680 creates a bulge 1686 along the shaft or near theneck of the bone fixation element 70″″. Alternatively, referring to FIG.19C, the bone fixation elements 70″″ may be inserted into the patient'sbone with the instrument or mandrel 1682 pre-inserted into thecannulated bore 1680. The instrument or mandrel 1682 including anenlarged distal end 1682 a so that, in use, removal of the mandrel orinstrument 1682 from the cannulated bore 1680 expands one or morefingers or other expandable members 1684 or creates a bulge 1686 alongthe shaft or near the neck of the bone fixation element 70″″.Alternatively, the bone fixation element 70′″ can be configured so thatinsertion of the mandrel or instrument 1682 expands a distal end of thebone fixation element 70″″, as shown in FIG. 19D.

Referring to FIGS. 20A-20C, the intervertebral implant 1700 of aneighteenth preferred embodiment includes the interbody spacer portion(not shown), the plate portion 1750 and first and second bone fixationelements 70. In the eighteenth preferred embodiment, the trajectories ofthe bone fixation holes 40 formed in the plate portion 1750, and hencethe trajectories of the first and second bone fixation elements 70, areconfigured so that the head portion 74 of the first bone fixationelement 70 is blocked or covered by the head portion 74 of the secondbone fixation element 70. Such a configuration limits the need toinclude additional retention mechanisms. Similarly, as shown in FIG.20C, a third bone fixation element 70 can be utilized in a similararrangement to at least partially cover the head portions 74 of thefirst and second bone fixation elements 70.

Referring to FIG. 21, the intervertebral implant 1800 of a nineteenthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 1850, a plurality of bone fixation elements 70 and theretention mechanism. In the nineteenth preferred embodiment, the headportion 74 of the bone fixation element 70 is preferably at leastpartially spherical and the bone fixation hole 40 formed in the plateportion 1850 is at least partially spherical. The maximum diameter ofthe head portion 74 is slightly larger than the entry diameter of thebone fixation hole 40. An interior diameter of the bone fixation hole 40is enlarged so that the interior diameter of the hole 40 accommodatesthe head portion 74 of the bone fixation element 70. As the bonefixation element 70 is inserted into the bone fixation hole 40, thespherical head portion 74 of the bone fixation element 70 snaps into thebone fixation hole 40 where it is polyaxially captured due to themaximum spherical diameter of the head portion 74 being larger than theentry diameter of the bone fixation hole 40.

Referring to FIG. 22, the intervertebral implant 1900 of a twentiethpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 1950, a plurality of bone fixation elements 70 and theretention mechanism. In the twentieth preferred embodiment, the bonefixation element 70 includes a cannulated bore 71 extending from aproximal end to an distal end of the bone fixation element 70 and one ormore fenestrations 71 a connecting the cannulated bore 71 to theexterior surface of the shaft portion 72 of the bone fixation element70. In use, the bone fixation element 70 is inserted through the plateportion 1950 and into the patient's bone. Bone cement 1980 is theninjected into the cannulated bore 71. The bone cement 1980 travelsthrough the cannulated bore 71 and the fenestrations 71 a and into thebone surrounding the shaft portion 72 of the bone fixation element 70.Upon curing, the bone cement 1980 secures the bone fixation elements 70with respect to the bone. The fenestrations 71 a may also be configuredto direct cement outflow adjacent to the leading surface 60 of the plateportion 1950 to assist in securing the plate portion 1950 to the bone.

Alternatively, referring to FIG. 22A, a filament 1982 may be used inplace of the bone cement 1980. In use, the filament 1982 is fed throughthe cannulated bore 71 after the bone fixation element 70 has beeninserted into the patient's bone. The filament 1982 preferably is sizedand configured to unwind after it is fed through the cannulated bore 71.The natural shape of the filament 1982 can be bent, spiral, or random,and an instrument can be used to unwind or straighten the filament 1982as it is being fed through the cannulated bore 71. Once the filament1982 is displaced out of the distal end of the bone fixation element 70,the filament 1982 returns to its original shape and forms a bulk ofmaterial 1984 which serves to enhance the anchoring of the bone fixationelement 70 to the bone and a position of the cannulated bone fixationelement 70 relative to the plate portion 1950.

Referring to FIGS. 23A and 23B, the intervertebral implant 2000 of atwenty-first preferred embodiment includes the interbody spacer portion(not shown), the plate portion (not shown), a plurality of bone fixationelements 70 and the retention mechanism. In the twenty-first preferredembodiment, the bone fixation element 70 includes a cannulated bore 71and is configured to be at least partially flexible. The bone fixationelement 70 can be manufactured from a shape memory alloy so that theshaft 72 assumes a geometry having at least one or more bends along itslongitudinal axis. A mandrel 2080 is inserted into the cannulated bore72. The mandrel 2080 serves to straighten the shaft 72 of the bonefixation element 70 so that the bone fixation element 70 can be insertedinto the bone fixation hole formed in the plate portion and into thepatient's bone (as shown in FIG. 23A). Thereafter, the mandrel 2080 isremoved resulting in the bone fixation element 70 returning to itsoriginal, bent geometry, which acts to prevent the bone fixation element70 from backing away from the bone and/or plate portion (as shown inFIG. 23B).

Referring to FIGS. 24A and 24B, the intervertebral implant 2100 of atwenty-second preferred embodiment includes the interbody spacer portion(not shown), the plate portion 2150, a plurality of bone fixationelements 70 and the retention mechanism. In the twenty-second preferredembodiment, the retention mechanism includes an eccentric ring 2180 thatis rotatably coupled to the head portion 74 of the bone fixation element70. In use, the bone fixation element 70 is inserted into the bonefixation hole formed in the plate portion 2150 and into the patient'sbone. Thereafter, the eccentric ring 2180 is rotated, e.g. 90 degrees,into a mating slot 2182 formed in the plate portion 2150 to block thehead portion 74 of the bone fixation element 70.

Referring to FIGS. 25A-25C, the intervertebral implant of a twenty-thirdpreferred embodiment includes the interbody spacer portion (not shown),the plate portion (not shown) and a plurality of bone fixation elements70. In the twenty-third preferred embodiment, the bone fixation elements70 include one or more radial slots 2280 formed in the shaft 72 thereof.The plate portion includes an internal spring-loaded pin or spring tab2282 that protrudes at least partially into the bone fixation holes 40.In use, advancement of the bone fixation elements 70 into the bonefixation holes 40 causes the spring-loaded tab 2282 to retract into aninterior bore formed in the plate portion until the bone fixationelement 70 is advanced a desirable amount with respect to the plateportion, at which point the spring-loaded tab 2282 expands into the bonefixation hole and engages the slot 2280 formed in the shaft portion 72of the bone fixation element 70 to lock the bone fixation element 70 tothe plate portion. The spring-loaded tab 2282 can extend along theinterior of the plate portion and may be configured to protrude into aplurality of bone fixation holes so as to lock a plurality of bonefixation elements 70 simultaneously, as schematically represented inFIG. 25C.

Referring to FIG. 26, the intervertebral implant 2300 of a twenty-fourthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 2350 and a plurality of bone fixation elements 70. Inthe twenty-fourth preferred embodiment, the bone fixation elements 70include a spring member 2380 radially coupled to the head portion 74thereof. In use, after the bone fixation element 70 has been insertedinto the bone fixation hole 40 formed in the plate portion 2350 and intothe patient's bone, a locking or set screw 2382 is inserted into a bore2381 formed in the head portion 74 of the bone fixation element 70. Thelocking or set screw 2382 interacts with the spring member 2380 causingthe spring member 2380 to radially expand into engagement with a groove2352 formed in the bone fixation hole 40 to thereby secure the bonefixation element 70 to the plate portion 2350.

Referring to FIG. 27, the intervertebral implant 2400 of a twenty-fifthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 2450 and a plurality of bone fixation elements 70. Inthe twenty-fifth preferred embodiment, the bone fixation elements 70 arepreferably in the form of a spiral blade 2480. The bone fixation holes40 formed in the plate portion 2450 include one or more guide slots 2482to enable the spiral blade 2480 to past therethrough. Due to itscontorted shape, the spiral blade 2480 rotates as it is being inserted,which can be done by inserting the distal end of the spiral blade 2480through the guide slots 2482 and impacting the proximal end of thespiral blade 2480 with a mallet or alternative instrument. The spiralblade 2480 rotates as it passes through the guide slots 2482 and cutsits way into bone. Once fully inserted, the guide slots 2482 and thehelical arrangement of the spiral blade 2480 prevent the spiral blade2480 from backing-out of the plate portion 2450.

Referring to FIG. 28, the intervertebral implant 2500 of a twenty-sixthpreferred embodiment includes the interbody spacer portion 2520, theplate portion 2550 and a plurality of bone fixation elements 70. In thetwenty-sixth preferred embodiment, the bone fixation elements 70 includean elastically deformable ring 2580. The elastically deformable ring2580 is preferably disposed around the head portion 74 of the bonefixation element 70. In use, as the bone fixation element 70 is advancedinto the bone fixation hole 40 formed in the plate portion 2550, theelastically deformable ring 2580 advances and is compressed until thering 2580 aligns and expands within a groove 2582 formed in the bonefixation hole 40 to thereby secure the bone fixation element 70 to theplate portion 2550. Alternatively, the elastically deformable ring 2580can be disposed within the groove 2582 formed in the bone fixation hole40 of the plate portion 2550. The ring 2580 compresses as the bonefixation element 70 is advanced into the bone fixation hole 40 until thering 2580 aligns and expands within a groove formed on the shaft, neck,or head portions of the bone fixation element 70.

Referring to FIG. 29, the intervertebral implant 2600 of atwenty-seventh preferred embodiment includes the interbody spacerportion 2620, the plate portion 2650 and a plurality of bone fixationelements 70. In the twenty-seventh preferred embodiment, the bonefixation elements 70 include a compressible head portion 74. The headportion 74 can be made compressible by counter boring and cutting radialslots 74 a to create spring fingers 74 b. The bone fixation holes 40preferably include one or more inwardly extending projections 2680 sothat during advancement of the bone fixation elements 70 into the bonefixation holes 40, the spring fingers 74 b are compressed by theprojections 2680. Once the head portion 74 is inserted past theprojections 2680, the head portion 74 radially expands to limit the bonefixation element 70 from backing-out relative to the plate portion 2650.

Referring to FIG. 30, the intervertebral implant 2700 of a twenty-eighthpreferred embodiment includes the interbody spacer portion (not shown),the plate portion 2750, a plurality of bone fixation elements 70 and theretention mechanism. In the twenty-eighth preferred embodiment, theretention mechanism includes a rotational or torsional spring element2780 rotatably coupled to the trailing surface 62 of the plate portion2750. The rotational or torsional spring element 2780 includes one ormore blocking pin portions 2782 attached thereto for at least partiallycovering the bone fixation holes 40. In use, as the bone fixationelements 70 are advanced into the bone fixation holes 40, theundersurface of the head portion 74 of the bone fixation 70 interactswith and pushes aside the blocking pins 2782 to allow the head portion74 of the bone fixation element 70 to pass thereby. Once the headportion 74 is advanced past the blocking pin portions 2782, therotational or torsional spring element 2780 returns the blocking pinportions 2782 to their original position at least partially covering thebone fixation holes 40. The rotational or torsional spring element 2780is preferably configured to rotate out of the way to enable the bonefixation elements 70 to be inserted. The rotational or torsional springelement 2780 preferably snap back into place to at least partially coverthe bone fixation holes 40 after the bone fixation elements 70 have beenfully inserted. Alternatively, the retention mechanism may be in theform of a lead spring. Furthermore, linkages can be attached to therotational or torsional spring element 2780 so that the linkages arepushed out of the way to enable the bone fixation element 70 to beinserted into the bone fixation holes 40 and return to at leastpartially cover the bone fixation holes 40. The rotational or torsionalspring element 2780 can also be manually rotated to manipulate thelinkages for locking and unlocking.

Referring to FIGS. 31A and 31B, the intervertebral implant 2800 of atwenty-ninth preferred embodiment includes the interbody spacer portion2820, the plate portion 2850, a plurality of bone fixation elements 70and the retention mechanism. In the twenty-ninth preferred embodiment,the retention mechanism includes a thin metallic web of material 2880.The metallic web of material 2880 having a hole 2882 and one or moreslots or fingers 2884 radiating from the hole 2882. The metallic web ofmaterial 2880 being deformable so that in use, the metallic web ofmaterial 2880 deforms as the bone fixation element 70 is being advancedtherethrough. The metallic web of material 2880 providing friction withthe threaded shaft portion 72 of the bone fixation element 70 to preventrotation and axial movement to thereby secure the bone fixation element70 to the plate portion 2850. The metallic web of material 2880 can alsobe disposed interior to the spacer portion 2820 to interact with thethreaded shaft portion 72 of the bone fixation element 70.

While the foregoing description and drawings represent the preferredembodiments of the present invention, it will be understood that variousadditions, modifications, combinations and/or substitutions may be madetherein without departing from the spirit and scope of the presentinvention as defined in the accompanying claims. In particular, it willbe clear to those skilled in the art that the present invention may beembodied in other specific forms, structures, arrangements, proportions,and with other elements, materials, and components, without departingfrom the spirit or essential characteristics thereof. One skilled in theart will appreciate that the invention may be used with manymodifications of structure, arrangement, proportions, materials, andcomponents and otherwise, used in the practice of the invention, whichare particularly adapted to specific environments and operativerequirements without departing from the principles of the presentinvention. In addition, features described herein may be used singularlyor in combination with other features. The presently disclosedembodiments are therefore to be considered in all respects asillustrative and not restrictive, the scope of the invention beingindicated by the appended claims, and not limited to the foregoingdescription.

1. A method of inserting an implant into an intervertebral disc spacebetween first and second vertebrae using an intervertebral implantsystem that comprises an implant inserter instrument and the implant,the method comprising the steps of: attaching the implant inserterinstrument to the implant; inserting the implant into the intervertebralspace along an insertion direction; abutting a stop of the system withat least one of the first and second vertebrae, such that the abutmentof the stop with the at least one of the first and second vertebraeprevents further insertion of the implant in the insertion direction;inserting a first bone fixation element through a first bone fixationhole of the implant and into the first vertebra, while the implantinserter instrument is attached to the implant; inserting a second bonefixation element through a second bone fixation hole of the implant andinto the second vertebra, while the implant inserter instrument isattached to the implant; and detaching the implant inserter instrumentfrom the implant.
 2. The method of claim 1, wherein the step ofinserting a first bone fixation element, and the step of inserting asecond bone fixation element are both performed while the stop isabutting the at least one of the first and second vertebrae.
 3. Themethod of claim 2, further comprising the step of repositioning at leastone of the first and second vertebrae, such that a distance between thefirst and second vertebrae decreases.
 4. The method of claim 1, whereinthe attaching step further comprises rotating a handle portion of theimplant inserter instrument to threadedly engage a threaded end of theimplant inserter instrument with a threaded borehole of the implant. 5.The method of claim 4, further comprising, after the step of insertingthe first bone fixation element, the step of blocking the first bonefixation element such that movement of the first bone fixation elementin a direction opposite the insertion direction is prevented.
 6. Themethod of claim 5, wherein the step of blocking the first bone fixationelement comprises the step of coupling a retention mechanism to theimplant such that the retention mechanism covers at least a portion ofthe first bone fixation element, thereby preventing back out of thefirst bone fixation element from the first bone fixation hole.
 7. Themethod of claim 6, wherein the blocking step is performed after thedetaching step, and the coupling step comprises threadedly engaging theretention mechanism with the threaded borehole of the implant.
 8. Themethod of claim 1, further comprising after the step of inserting thefirst bone fixation element, the step of blocking the first bonefixation element such that movement of the first bone fixation elementin a direction opposite the insertion direction is prevented.
 9. Themethod of claim 8, wherein the step of blocking the first bone fixationelement comprises the step of coupling a retention mechanism to theimplant such that the retention mechanism covers at least a portion ofthe first bone fixation element, thereby preventing back out of thefirst bone fixation element from the first bone fixation hole.
 10. Themethod of claim 8, further comprising, after the step of inserting thesecond bone fixation element, the step of blocking the second bonefixation element such that movement of the second bone fixation elementin a direction opposite the insertion direction is prevented.
 11. Themethod of claim 10, wherein the step of blocking the second bonefixation element comprises the step of coupling a retention mechanism tothe implant such that the retention mechanism covers at least a portionof the second bone fixation element, thereby preventing back out of thesecond bone fixation element from the second bone fixation hole.
 12. Themethod of claim 11, wherein the step of blocking the first bone fixationelement comprises the step of coupling a retention mechanism to theimplant such that the retention mechanism covers at least a portion ofthe first bone fixation element, thereby preventing back out of thefirst bone fixation element from the first bone fixation hole, and thestep of blocking the second bone fixation element comprises the step ofcoupling the retention mechanism to the implant such that the retentionmechanism covers at least a portion of the second bone fixation element,thereby preventing back out of the second bone fixation element from thesecond bone fixation hole.
 13. The method of claim 1, wherein theimplant inserter instrument comprises the stop, and the abutting stepfurther comprises abutting the stop with one of the first and secondvertebrae, such that the abutment of the stop with the one of the firstand second vertebrae prevents further insertion of the implant in theinsertion direction.
 14. The method of claim 13, wherein the abuttingstep further comprises abutting the stop with the other of the first andsecond vertebrae, such that the abutment of the stop with the other ofthe first and second vertebrae prevents further insertion of the implantin the insertion direction.
 15. The method of claim 13, wherein the stopis a first stop, the implant inserter instrument comprises a secondstop, and the abutting step further comprises abutting the first stopwith the one of the first and second vertebrae, and abutting the secondstop with the other of the first and second vertebrae.
 16. The method ofclaim 1, wherein the abutting step further comprises abutting the stopwith one of the first and second vertebrae, such that the abutment ofthe stop with the one of the first and second vertebrae prevents furtherinsertion of the implant in the insertion direction.
 17. The method ofclaim 16, wherein the abutting step further comprises abutting the stopwith the other of the first and second vertebrae, such that the abutmentof the stop with the other of the first and second vertebrae preventsfurther insertion of the implant in the insertion direction.
 18. Themethod of claim 16, wherein the stop is a first stop, the systemcomprises a second stop, and the abutting step further comprisesabutting the first stop with the one of the first and second vertebrae,and abutting the second stop with the other of the first and secondvertebrae.
 19. The method of claim 1, wherein the abutting step furthercomprises abutting the stop with a surface of the at least one of thefirst and second vertebrae that does not face the intervertebral space.20. The method of claim 19, wherein the abutting step further comprisesabutting the stop with at least one of an anterior aspect, a lateralaspect, and an anterior-lateral aspect of the at least one of the firstand second vertebrae.